exam 3 hormones, metabolism, immunity, inflammation

hyperglycemia S/S

nausea dry skin fatigue deep rapid breathing thirst impaired vision polyuria polydispea

assessment type 1 diabetes

often suddenly as severe hyperglycemia/ DKA decreased weight loss in short period ketones/glucose in urine polyuria polyphagia polydipsia excess thirst fruity breath confusion

foot care type 1&2 diabetes

proper footwear/protective shoes avoid injury carefully inspect daily casting to redistribute weight debridement advanced-wound healing products vacuum assisted closure ultrasound hyperbaric O2 skin grafting

nursing interventions after head injury in Diabetes insipidus

provide adequate fluids within easy reach assess and report changes in neuro status monitor for: -constiation -wight loss -hypotension -tachycardia

thyroid

secretes hormones that regulate growth, metabolism, and appetite secretes calcitonin which decreases excessive Ca+ in blood by decreasing the bone reabsorption (release)

S/S of hypothyroidism

(everything slows down) Cold intolerance Weight gain Lethargy Fatigue Memory deficits confusion Poor attention span Muscle cramps Constipation Decreased fertility Puffy face Hair loss (eybrows) dry coarse hair Brittle nails dry skin bradycardia (decreased HR) depression weight gain despite decreased appetite arthritis

nursing interventions of diabetes insipidus

-Daily weight -I&O -labs (electrolytes, urinalysis, etc.) -medications -IV fluids + electrolytes -encourage intake of oral fluids -promote safety

hypoglycemia type 1&2 diabetes management

-blood glucose < 70 mg/dL begin treatment "rule of 15" -ingesting 15 g of simple carbs (4-6 oz of fruit juice or regular soft drink) -recheck blood glucose in 15 min. -if still <70 mg/dL, ingest 15 g more -repeat 2-3 x , if no change, contact HCP

sick day rules

-monitor sugar q4 hours -continue take insulin -sugar free non caffeinated liquids -test ketones q3 hours -rest -eat as normally as possible -daily weight (unintentional weight loss is sign of hyperglycemia) -call if glucose is greater than 240 or fever of 102

risk factors type 1 diabetes

Genetic predisposition, Exposure to a virus other autoimmune disorders

Treatment of hypoparathyroidism

IV Calcium. Phosphorus binding drugs Vitamin D to increase absorption of Ca+ foods high in calcium long term med treatment avoid spinach and rhubarb

interventions inflammation

RICE anti-inflammatory meds antibiotic/steroids adequate fluids

Nursing interventions of SIADH

VS monitory F&E monitoring and replacement I&O *fluid restriction med to inhibit ADH (flurosemide)

type 1 diabetes

absolute deficiency of insulin r/t pancreatic beta cell destruction autoimmune disorder

complications hypothyroidism

addison's disease

which nursing action is most helpful in preventing transmission of influenza in crowded communities? a. teaching correct hand-washing techniques b. demonstrating to cover the mouth when coughing c. educating about the importance of having annual vaccinations d. giving antiviral medications within 48 hours of symptom onset

c

which factors can predispose a client with type 1 diabetes to a diabetic ketoacidotic coma? select all that apply a. taking too much insulin b. getting too much exercise c. excessive emotional stress d. running a fever with the flu e. eating fewer calories than prescribed

c, d rational: the other answers were symptoms of hypoglycemia. ketoacidosis is r/t to hyperglycemia

lifespan diabetes insipidus

children and older adults: increased risk of dehydration pregnant people: increased risk of complications r/t dehydration

lifespan hypothyroidism

congenital: cretinism, manifests as severe physical and mental challenges -all newborns screened

finding of infiltration of an IV not inflammation

coolness

Immunity assessment

general state of health and nutrition health Hx: immunizations, past infections, meds, TB skin test, allergies, stress, chronic condition height and weight (BMI) VS lymph nodes skin and mucous membranes joints

Diabetes Insipidus risk factors

genetics kidney disorders

causes/risks hyperthyroidism

graves (most common) goiters adenomas family Hx other autoimmune disorders

causes/ risk factors of hypothyroidism

hashimotos (autoimmune disorder) tumor surgery to remove tumor iodine deficiency women over 65

Risks/Etiology of SIADH

head injury cancer metabolic disorder sometimes happens w/ children who have pneumonia/meningitis elderly at risk of hopitalization

risk factors inflammation

injury risk: children/elderly poor hygiene poor sanitary conditions poor nutrition smoking pollution exposure presence of autoimmune disease allergy Hx uninsured-limited access to health care

s/s of hypoparathyroidism

rare hypocalcemia symptoms: - tetany - tingling lips - stiffness - spasms - dysphagia - laryngospasm - lethargy - anxiety - decrease in Ca+ - decrease in PTH - increase in serum phosphate

cellulitis interventions

topical: moist heat, immobilization, elevation systemic: systemic antibiotic therapy, IV antibiotic (vancomycin) progression to gangrene possible if left untreated

Causes of hyperparathyroidism

tumor secondary to renal failure paraneoplastic syndrome increased secretion of PTH= increase in Ca+ levels -compensatory response loss of bone Ca+ can lead to osteoporosis

nursing planning/health promotion of type 1&2 diabetes

maintain blood glucose levels diet: low in fat, total cal, processed, foods; high in whole grains, fruits, veggies exercise 150min/week

nursing interventions immunity

maintain std. precautions maintain protective precautions assess nutritional intake educate: -healthy eating -weight -exercise -sleep/rest -stress management

patient teaching type 2 diabetes

obtain finger stick BG reading before meals s/s of hypoglycemia sick day rules

s/s of diabetes insipidus

excretion of large amounts of fluid (polyuria) extreme thirst(polydipsia) low specific gravity occur 3-6 days after a head injury dilute urine nocturia S/S of FVD (decreased BP; increased HR) dry mucous membranes

treatment of hypothyrodism

lifetime on thyroid replacement hormone myxedema coma- medical emergency (ER)

Assessment hyperthyroidism

look for S/S especially decreased weight despite increased appetite, tachycardia, dysrhythmias, palpitations obvious signs: eye protrusion, goiter

Dx tests for immunity

CBS C-reactive protein (CRP) erythrocyte sedimentation rate (ESR)- cancer, autoimmune disease specific antibodies

inflammation chronic

Chron's peptic ulcer disease rheumatoid arthritis (autoimmune diseases)

S/S of hyperthyroidism

Everything speeds up Hair loss Bulging eyes Sweating Enlarged thyroid (goiter) Rapid HR Weight loss Frequent bowel movements Warm, moist palms Tremor of fingers Soft nails Heat intolerance Difficulty sleeping

the nurse is providing immediate postoperative care to a client who had a thyroidectomy. The nurse would monitor for a. urinary retention b. signs of restlessness c. decreased blood pressure d. signs of respiratory obstruction

Signs of respiratory obstruction Rational: tracheal compression can occur because of edema in the surgical area

which example illustrates health promotion activities? select all that apply a. good nutrition b. regular exercise c. physical awaremess d. immunization against measles e. education about stress management

a, b

which manifestation may indicate the client with type 1 diabtes has insulin-induced hypoglycemia? select all that apply a. excessessive hunger b. weakness c. diaphoresis d. excessive thirst e. deep respirations

a, b, c rational: excessive thirst and deep respirations are r/t hyperglycemia

which action would the nurse implement when client develops an anaphylactic reaction? select all that apply a. initially, apply oxygen at 90% to 100% per nasal cannula b. call rapid response team and have the crash cart retrieved c. elevate the head of the bed to 45 degrees d. assign unlicensed assistive personnel to stay with the client e. ensure emergency airway equipment is at the bedside f. intubate the client with a size 7 endotracheal tube and initiate cardiopulmonary resuscitation (CPR)

a, b, c, e

a client with type 1 diabetes for 25 years states, " I have been really bad for the past 15 years. I have not paid attention to my diet and have done little to control my diabetes." which common complications of diabetes might the nurse expect to identify when assessing this client? select all that apply. a. leg ulcers b. loss of visual acuity c. thich, yellow toenails d. increased growth of body hair e. decreased sensation in feet

a, b, c, e rational: think about what hyperglycemia causes

which assessment finding would the nurse associate with cushing disease? select all that apply a. round face (moon face) b. dependent edema in feet and ankles c. increased fatty deposition in the extremities d. thin, translucent skin with bruising e. increased fatty deposition in the neck and back. (buffalo hump)

a, b, d, e rational: increased levels of steroids and aldosterone cause sodium and water retention in clients with cushing syndrome

assessment of hypothyrodism

benign nodules may be present sometimes goiter all infants screened at birth labs: decreased T3, TSH, thyroid antibodies closely watch for difficulty breathing swallowing, rapid weight loss/gain

which effect does increased parathyroid hormone have on bones and electrolytes? select all that apply a. increased bone breakdown b. increased serum calcium levels c. increased sodium and phosphorus excretion d. increased absorption of calcium and phosphorus e. increased net release of calcium and phosphorus

a, b, e rational: bone breakdown increases serum calcium levels. the parathyroid hormone increases the release of calcium and phosphorus from bone into extracellular fluid. increase in sodium and phosphorus excretion by the kidneys not in bone. increase of absorption of calcium and phosphorus in GI by using activated vitamin D (not related to bones).

which client statement indicates that the client understands the nurse's instructions about long-term steroid therapy? a. my urine may become discolored b. i should avoid crowds in enclosed areas c. weight loss can occur with this medication d. the medication should be taken between meals

b

which responses would the nurse expect a client experiencing hypoglycemia to exhibit? select all that apply a. nausea b. palpitations c. tachycardia d. nervousness e. warm, dry skin f. increased respirations

b, c, d rational: the sympathetic nervous system is stimulated by the decline of blood glucose.

which symptoms would the nurse observe in a client with hyperglycemia and ketoacidosis? select all that apply a. irritability b. dry skin c. diaphoresis d. increased thirst e. deep rapid breathin

b, d, e rational: thirst is a compensatory mechanism that causes a person to drink b/c of dehydration. deep, rapid breathing is the body's attempt to correct the metabolic acidosis associated with ketoacidosis by blowing off CO2.

which cause of tremors, pallor, and diaphoresis would be suspected in a client with type 1 diabetes? a. overeating b. viral infection c. aerobic exercise d. missed insulin dose

c. rational: the client is experiencing hypoglycemia the other responses are causes of hyperglycemia

which action will the nurse take when caring for a client whose IV site is tender with erythema, warmth, and mild edema?

change the IV site to prevent thrombophlebitis

which action will the nurse take after stopping the antibiotic infusion of a client who becomes restless and flushed, and begins to wheeze during the administration of an antibiotic? a. check temperature b. take BP c. obtain SpO2 d. assess respiratory status

d

Treatment of Cushing's Syndrome

decrease corticosteroid dosage surgery to remove tumor decrease Na+ levels decrease blood glucose increase calcium

Causes of hypoparathyroidism

decreased secretion: Autoimmune damage/trauma to parathyroids surgical excision (removal of part of or all of thyroid)

which outcome would be expected after a client received treatment for Cushing disease? a. increased cortisol levels. b. increased sodium levels c. decreased blood glucose levels d. decreased serum calcium levels

decreased serum calcium levels rational: cushing disease affects glucose metabolism and results in reduced glucose uptake by tissues and increased blood glucose levels.

psychologic management of type 1&2 diabetes

depression= diminished self-care anxiety eating disorders (adolescent girls w/diabetes more than 2x likely to have) diabulimia: intentional decrease of insulin for weight loss open communication is critical to identify these problems

consistant glucose control type 1&2 diabetes

diet exercise regular glucose checks insulin admin.

patient teaching hypothyroidism

disease process and treatment do not abruptly stop meds stay under close health care supervision report any change in symptoms to HCP lifetime medication

cellulitis assessment

hot tender erythema edematous area w/ diffuse borders chills malaise (discomfort uneasiness in general) fever

s/s of hyperparathyroidism

hypercalcemia -decrease in appetite -constipation -fatigue -emotional disorders -muscle weakness -osteoperosis -kidney stones -cardiac changes

assessment type 2 diabetes

hyperglycemia: -thirst -polyuria -polydipsia -blurred vision -fatigue Hx of increased subseptibility to infections (yeast infection; poor wound healing) -Hgb A1C > 6.5%

exaggerated immune/inflammatory response

hypersensitivity allergy greater localized/systemic autoimmune response-type 1 diabetes, rheumatoid arthritis, lupus, body is attacking itself

treatment type 1 diabetes

insulin large col. isotonic/hypotonic fluids at first monitor for s/s of hypoglycemia monitor blood glucose hourly monitor for hypokalemia long-term: manage w/ diet and exercise; consistent blood glucose control

etiology type 2 diabetes

insulin resistance/deficiency inadequate insulin to meet body's needs develops over period of years acute presentation manifested as HHS (hyperglycemic hyperosmolar syndrome) often after acute illness/infection very similar to DKA just no acidosis

Cellulitis risk factors

lesion staphylococcus aureus streptococci deep inflammation of subcut, tissue from enzymes produced by bacteria

nursing interventions hyperthyroidism

watch iodine in diet regular exercise monitor VS med education and symptom/disease management support during hormone level adjustment/regulation

Addison's disease

occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone fatigue lethargy muscle weakness low mood or irritability loss of appetite unintentional weight loss polyurea increase thirst craving for salty foods

assessment inflammation

pain redness swelling heat can be localized or systemic anaphylaxis

hypoglycemia S/S

palpitations tachy sweat fatigue hunger nervousness vision changes seizures, coma numbness of finger, toes, mouth anxiety tremors slurred speech dizziness/ faintness unsteady gait headache emotional changes cold, clammy skin weakness diaphoresis

Treatment of hyperthyroidism

- Radioactive iodine (I131) works by destroying the thyroid gland - Surgery to remove all or part of the thyroid gland - Lifelong thyroid hormone replacement will be needed

nursing care hyperparathyroidism

-decreased Ca in diet -monitor I & O -monitor S/S of kidney stones (strain urine) -3 to 4 liters of fluid daily ( large vol. of isotonic solution and increased PO fluid) -frequent rest periods -weight bearing exercise to increase Ca+ to bones -fall prevention (risk of fracture due to weak bones) -educate on disease process

Assessment of Cushings Syndrome

-increased blood glucose -marked Na+ and H2O retention -hypervolemia and hypokalemia -moon face -buffalo hump -striae on abdomen -thin skin -bone pain -weak muscles -osteoporosis -dependent edema in feet and ankles from excretion of K+ and retention of Na+

which manifestation would the nurse include when teaching a client about ketoacidosis? select all that apply a. confusion b. hyperactivity c. excessive thirst d. fruity breath e. decreased urine output

a, c, d rational: not enough insulin so body breaks down fat which causes buildup of ketones ( think about hyperglycemia)

the nurse is educating a client newly diagnosed with type 2 diabetes on oral antidiabetic medications. Which instruction would the nurse include in the teaching plan? a. the client should obtain a finger-stick blood glucose reading before each meal b. the client does not need to follow a specific diet until insulin is required c. teaching plan should includes s/s of hypoglycemia d. teaching plan should include how to administer regular insulin e. teaching plan should include sick day rules

a, c, e rational: focus is on oral antidiabetic medications so administration of regular insulin is not part of the teaching plan

which interventions would the nurse implement in caring for a client with diabetes insipidus after a head injury? select all that apply a. provide adequate fluids within easy reach b. report an increasing urine specific gravity c. administer prescribed erythromycin d. assess for and report changes in neurological status e. monitor for constipation, weight loss, hypotension, and tachycardia

a, d, e, rational: focus of care is maintaining F&E balance b/c of underproduction of ADH

which finding would be expected in a client with a history of hypothyroidism? select all that apply a. cold intolerance b. lethargy and fatigue c. hemoglobin 11.2 g/dL (L) d. 15 lbs weight gain e. heart rate 59 bpm

all rational: decreased metabolism from low thyroid hormone levels

Cushing syndrome cause

disorder of adrenal gland hypercortisol too much corticosteroid admin. (asthma/chronic inflammatory states) pituitary or adrenal tumor that secretes hormones

nursing interventions type 1 diabetes

-protect airway -replace fluids -monitor K+ level -monitor vital signs -monitor blood glucose levels -monitor I &O and weight -Monitor skin integrity and healing status of any wounds -proficiency at self-administering medication -teach personal hygiene -provide nutritional guidelines -assist with an exercise plan -teach the child illness management guidelines -teach manifestations of hypoglycemia -teach manifestations of hyperglycemia medications: insulin pumps, insulin injections

inflammation acute

sprain bee sting

Immunity risk factors

age nonimmunized state environment (pollutants/smoking) chronic illnesses medical treatments (chemo) genetics (autoimmune disorders/allergies) high-risk behaviors pregnancy elderly decreased thymas= decreas T lymphocytes gender race ethnicity environmental or medication exposure

types of altar'd immunity

exaggerated immune/inflammatory response suppressed immune response

suppressed immune response

not enough of a response can be primary (born with) or secondary (caused by)

risks type 2 diabetes

obesity primary first degree relatives sedentary lifestyle ethnic pop. (black, hispanic, native american, pacific islander, asian ameriacn) women delivery of baby > 9 lbs or had gestational diabetes HTN high cholesterol

parathyroid glands

posterior side of thyroid calcitonin works in conjunction with to: - reduce calcium levels which -stimulates parathyroid hormone when Ca+ is released and stimulated bone reabsorption reabsorption of Ca+ in the kidney -increased vitamin D

treatment hyperparathyroidism

surgical if extreme increase in IV fluids to lower serum Ca+ monitor Ca+ intake

SIADH

syndrome of inappropriate antidiuretic hormone -excessive release of ADH -causes excessive water retention -causes hyponatremia

pharmacologic diabetes insipidus

synthetic ADH hormone by -injections -pills -intranasal spray

which complication would the nurse be concerned about if there is removal of the parathyroid glands during a thyroidectomy? a. tetany b. myxedema c. hypovolemic shock d. adrenocortical stimulation

tetany rational: parathyroid removal eliminates body's source of parathyroid hormone, which increases blood calcium level. the resulting low body fluid calcium. affects muscles resulting in tetany

assessment & S/S of SIADH

hyponatremia (diluted Na+ from FVE) FVE N/V increase in weight from fluid retention memory impaired seizures/coma